Provider Demographics
NPI:1073259057
Name:DEWBERRY, JUSTIN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
Last Name:DEWBERRY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 DECKER CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6416
Mailing Address - Country:US
Mailing Address - Phone:804-305-4139
Mailing Address - Fax:
Practice Address - Street 1:1112 DECKER CT
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-6416
Practice Address - Country:US
Practice Address - Phone:804-305-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty